Provides data management support services to Dignity Health’s CI/ACO Networks, Employer Relations and Valued Based Operations (VBO).
Within the Salesforce platform, this individual gathers and maintains accurate provider data, performs periodic provider data reconciliations with multiple data sources.
Maintains and transmits fee schedules, as necessary, to third-party administrators (TPA's) and other appropriate stakeholders.
Lead the preparation and submission of comprehensive provider rosters to Managed Medicare, Medicaid, and commercial payers.
Audit internal provider data against database records to ensure 100% accuracy before submission.
Serve as the primary point of contact for health plans to resolve roster discrepancies, rejections, or paneling delays.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs.
Lead and supervise credentialing support staff, ensuring quality, accuracy, and timely processing of credentialing and enrollment tasks.
Oversee provider credentialing, licensure, and internal enrollment with Medicare, Medicaid, Managed Care, and Commercial Plans.
Maintain provider rosters, monitor license and certification renewals, and ensure compliance with regulatory and internal standards.
At Better Life Partners, we provide what it takes to heal from addiction. Wherever. Whenever. By combining virtual and in-person counseling, community support, and medication access.
The Provider Enrollment Specialist is responsible for timely and effectively enrolling practitioners in health plans. The Specialist will monitor progress, ensure timeliness of enrollment completion, and provide updates. The Specialist will maintain accurate provider profiles in IntelliCred and CAQH.
Pediatrix Medical Group is one of the nation’s leading providers of specialized health care for women, babies and children since 1979.
Owns end to end operations and expansions for our provider networks in the US & Canada.
Deeply understand and elevate Carrot’s strategic positioning within the US & Canada healthcare and provider ecosystems.
Define and deliver on KPIs related to provider network operations response including establishing goals, methodology on measurement/tracking, and execution.
Carrot is a global, comprehensive fertility and family care platform, supporting members and their families through life's memorable moments. They are trusted by multinational employers and health plans, offering localized support in over 170 countries and 25 languages.
This role involves overseeing the strategic and operational management of a healthcare provider network. The role ensures network design, credentialing, enrollment, data management, and compliance meet regulatory and accreditation standards. The position emphasizes operational excellence, strategic oversight, and effective provider relationship management.
Jobgether uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements.
Develop deep understanding of the clinical data needs and data usability requirements across Devoted Health Plans and Devoted Medical.
Analyze clinical data availability across geographical areas to develop insights about data gaps, the reasons data is not available, and opportunities to obtain data.
Implement technical integrations with Health Information Exchanges (HIEs), Labs, Electronic Health Record (EHR) systems, and other sources of clinical data and ensure quality of data received.
Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. Founded in 2017, they've grown fast and now serve members across the United States.
Be the primary point of contact for all providers.
Provide professional, accurate and timely responses to all provider inquiries.
Maintain a current knowledge of all contract requirements and objectives.
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans.